Family Physician Carlos Yu has been exposed to more emergency room visits due to self-harm among teens than he cares to count, in Canada. With equal importance for South African parents, he offers invaluable advice.

Many teenagers who self-harm do so to cope with overwhelming thoughts and emotions. (iStock)

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The below piece has been written by Canadian Family Physician Carlos Yu for The Conversation but he presents well-researched information and advice that remains relevant for South African parents facing similar mental health struggles with their teens.

I recently worked a shift in the emergency room at a Toronto-area hospital and was asked to see a 12-year-old boy who had cut himself for the first time, on his wrist.

Cutting with razors, knives or other sharp objects is a common method of inflicting “self-harm” — deliberate attempts to hurt oneself, without conscious suicidal intent. Other methods include burning or hitting oneself.

Like many, this boy did not know exactly why he did what he did; so I talked it through with him while I repaired his laceration. He left smiling and satisfied. His mom sent me an email today thanking me for taking care of her son.

Why young people self-harm

I recall another incident last year, with another 12-year-old boy who had cut himself. This was his third emergency room visit for cutting; the story was that “he began cutting only after having met a female friend who cuts.”

I asked him why he cuts? He looked up briefly and said it’s because “everyone hates me.” I asked him why if others hate him, they aren’t doing the cutting. He looked puzzled.

I then asked him if it is possible that he is struggling with difficult feelings or thoughts that he can’t stop, and if he is using the pain of cutting to interrupt them. He looked up and held my gaze for the first time and nodded his head.

I asked him what else he does to stop these thoughts and feelings. Does he play video games? He quickly denied it. His mom pointed out that he plays hockey and has no time to waste. So I asked him again what else he does to stop his thoughts. His mom looked surprised when he finally said he punched walls.

I asked him if the pain helps him stop his thoughts and feelings. He said yes. I then asked him what else? He said he banged his head against walls.

Like many others who self-harm, this boy is cutting himself in an attempt to cope with events in his life, and the overwhelming emotions and thoughts that arise.

Slowly trace the outline of the spread hand with the index finger of the opposite hand in the following way.

Wait for the next (preferably involuntary) breath.

Trace up the digit with each inspiration.

Trace down the digit with each expiration.

Repeat until the entire spread hand is traced.

I explained to him that by intentionally paying attention to the sensation of his breath and the tracing of his hand, he can redirect his attention away from his difficult thoughts and feelings without the the pain and trouble of his current methods.

I encouraged him to practise this new technique at every chance he gets. I suggested that his ability to direct his attention will improve with these regular practices — just like hockey drills improve his play.

A technique like Take Five can offer an alternative way of redirecting attention away from difficult thoughts and emotions. iStock

Encouraging preliminary evidence suggests that therapists can foster mindfulness, in a relatively brief period of time and that mindfulness can affect a variety of processes thought to contribute to suicidal behaviour.

Opportunities for greater understanding

Before he left, I asked this boy if anyone else in his family suffered difficulty with thoughts and feelings. He said “my twin.” I asked, “who else?” He pointed to his mom.

I asked, “what about when your dad loses his temper and yells at you about hockey?” He thought and began smiling and nodding. So I suggested that he might find an appropriate moment to share his new knowledge and Take Five with his father.

He held my gaze continuously. In my peripheral vision, I noticed he had continued to practise Take Five by tracing his hand.

I suggested to him that many people struggle with these challenges and that he is not alone. I explained that by developing his ability to choose the object of his moment to moment attention, he can develop self-compassion and open many exciting possibilities.

I also pointed out to him that even the Olympic silver medallist may cry for being only the second best; that the “worst” player exhibits great courage for simply being part of the game; and that everyone has the right to be happy.